| NPI | 1104296417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELLA GRACE IMMANUEL Owner 318-215-8150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: LA MD12866R) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-11-03 |