| NPI | 1861593436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L RADA Billing Supervisor 318-443-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |