DIVINE HEALTH PRIMARY CARE CLINIC, LLC

RUSTON, LA
NPI1548528854
Doing Business AsDIVINE HEALTH AND PRIMARY CARE CLINIC
Entity TypeOrganization
Authorized ContactOFUNDEM ROSE GWAN
Owner/Physician
318-259-1204
Organization Subpart ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: LA  203609)
Enumeration Date2012-04-25
Last Update Date2012-04-25
Business Address
DIVINE HEALTH PRIMARY CARE CLINIC, LLC
1401 EZELL STREET
RUSTON, LA 71270-7218
Phone number: 318-259-1204
Mailing Address
DIVINE HEALTH PRIMARY CARE CLINIC, LLC
1401 EZELL STREET
RUSTON, LA 71270-7218
Phone number: 318-259-1204
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