| NPI | 1821225806 |
|---|---|
| Former Legal Business Name | NO |
| Entity Type | Organization |
| Authorized Contact | DEWARRENT L. BRANTLEY CEO/ President 318-678-0709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2009-06-17 |