| NPI | 1487141230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD THOMAS SIPES Owner 318-935-6177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2020-01-15 |