| NPI | 1407901978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWITT GINN Owner Office Manager 225-654-4290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: LA 1416142) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-08-22 |