| NPI | 1417085192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKIE EDWARD JOHNSON Owner 337-232-3371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: LA A10226) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |