| NPI | 1477210342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN FULMER Director Of Clinic Operations 318-372-2017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2021-11-26 |