| NPI | 1629504220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA MOSSALLATI Member Manager 318-425-4096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 303623) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2017-05-03 |