| NPI | 1003430257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM LEGENDRE BOUDREAUX Contract Manager 985-493-4907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-06-02 |