| NPI | 1467509232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLIE LEE BETHEA Owner 318-377-0587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: LA apo 03674) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |