| NPI | 1588833651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALENCIA FULLER MAGEE Owner 225-910-1953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: LA 7156) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-22 |