| NPI | 1598475246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDER IRENE PUCKETT President 318-464-7504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2024-02-26 |