| NPI | 1265811087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY ESCHETTE Certified Surgical First Assistant 985-805-0921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: LA 140601) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2015-10-06 |