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 | 2020-12-11 |