NPI | 1730156845 |
---|---|
Entity Type | Organization |
Authorized Contact | GLADYS T BUSH Administrator 318-797-8777 |
Organization Subpart ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: LA 00181035) |
Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
Enumeration Date | 2006-03-07 |
Last Update Date | 2022-04-27 |