| NPI | 1376191627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICE DUNN Manager 318-429-2443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2019-12-07 |