| NPI | 1568690535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THANE BATTISTE PAINIA Manager 225-620-1561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2009-06-29 |