| NPI | 1295040350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE V ACOSTA Sole Mbr 985-898-2274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: LA L020533) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2010-08-13 |