| NPI | 1598804486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY BRIDGES Administrator 318-227-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: LA 14) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2013-09-12 |