| NPI | 1033397047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALETA NATASHA DECLOUET Owner 985-781-7577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: LA 10807R) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2010-11-04 |