NPI | 1104128826 |
---|---|
Entity Type | Organization |
Authorized Contact | PHILIP SIDNEY WEISS Physician 985-640-0920 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: LA MD201537) |
Enumeration Date | 2010-12-01 |
Last Update Date | 2010-12-01 |