| NPI | 1861581092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES MCCLUNG Administrator 318-232-7186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: LA 87) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |