| NPI | 1831631043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE MARTIN ENNIS Owner 985-200-3530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: LA 201758) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |