| NPI | 1124811450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINETTE RABENALDT Credentialing Coordinator/Hr 337-330-2576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-05-28 |