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 |