| NPI | 1699021410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MICHAEL AGENA Md/Owner 985-845-7121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: LA MD200946) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |