| NPI | 1053315846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE W. SMITH Administrator 318-798-4598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2025-04-01 |