| NPI | 1104297720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELLA GRACE IMMANUEL Owner 318-221-0277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: LA MD12866R) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-11-03 |