| NPI | 1053594507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY CLYDE DANIELS Owner, Sole Member 318-934-0082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 06282R) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2007-12-12 |