| NPI | 1124738307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA FOSTER Credentialing Specialist 225-306-2067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2022-11-29 |