| NPI | 1679123632 |
|---|---|
| Doing Business As | EQUILYST MODERN MEDICINE |
| Entity Type | Organization |
| Authorized Contact | WILLIAM BLAKE YORK Managing Member 337-580-0710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2019-09-12 |