| NPI | 1861646739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERTRUDE GBOLOO Owner 225-644-1990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.202326) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2008-11-05 |