| 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 |