| 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 |