| NPI | 1457660797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUY KEN SMITH Director Operations 985-898-7091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 11217) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2014-05-01 |