| NPI | 1508237256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELLA GRACE IMMANUEL Md 318-730-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: LA MD12866R) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |