| NPI | 1023260486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA TENNANT Business Owner 318-410-1044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 07043R) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2008-10-20 |