| NPI | 1275269946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA NICOLE HAVLIK CEO 337-501-3934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2022-11-03 |