| NPI | 1720508955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DIES President 337-580-4061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2018-04-28 |