NPI | 1295261519 |
---|---|
Entity Type | Organization |
Authorized Contact | TRACY FRENTZ Practice Manager 337-254-9980 |
Organization Subpart ? | No |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: LA MD.024773) |
Enumeration Date | 2017-05-05 |
Last Update Date | 2019-03-12 |