| NPI | 1053021667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE WEBRE Clinic Manager 985-492-6170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-06-20 |