| NPI | 1528764313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE FUSSELL Owner 985-287-1579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2024-05-16 |