| NPI | 1265749519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE EDWIN ELLIOTT President 318-388-4863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 10533) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2011-11-01 |