| NPI | 1255010617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE AVERETT KLUMPP Owner 337-476-5071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2023-07-13 |