| NPI | 1205075256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER H HERTZAK Owner 985-641-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: LA 05273R) |
| Enumeration Date | 2009-02-16 |
| Last Update Date | 2009-04-15 |