| NPI | 1285635540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT PENN Medical Director 318-798-5930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: LA 29816-2647) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-08-22 |