| NPI | 1164811881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY ALLEN COMEAUX Doctor/ Owner 225-408-2820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD204025) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2019-11-06 |