| NPI | 1508182197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK DAVID FAIR Owner/Physician 318-352-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.202650) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |