| NPI | 1710052378 |
|---|---|
| Other Name | NONE |
| Entity Type | Organization |
| Authorized Contact | NICOLE KERLEY Owner 985-688-0238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD.024810) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2011-10-06 |