| NPI | 1558683615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CURTIS A EDWARDS Clinical Director 318-238-3773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: LA 451) |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2010-02-17 |