| NPI | 1689182792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEESHA S DINKINS Business Manager 318-688-8190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0800X Clinic/Center, Recovery Care |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2019-07-24 |