| NPI | 1235770249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ALAN DAUGHERTY Manager/Owner 318-372-7510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2019-10-01 |