| NPI | 1538977350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE DAWN BRUMFIELD Program Manager 318-528-5131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2024-12-26 |
| Last Update Date | 2024-12-26 |