| NPI | 1346755154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN JOSEPH MILLER President 337-447-4027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: LA 2203783812) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2018-06-19 |