| NPI | 1255388419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM EVANS RUSSELL Medical Director 225-387-7280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA 174400000X) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2020-08-22 |