| NPI | 1275769119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANO THORNTON Executive Director 318-648-0375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2019-06-26 |