| NPI | 1558797639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELO ANTHONY TARVER Medical Director 225-634-6311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: LA AP07348) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2013-09-19 |