NPI | 1871025387 |
---|---|
Entity Type | Organization |
Authorized Contact | KENYATTA SHAMLIN-HAYNES Part Owner 225-405-6381 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: LA la025911) |
Enumeration Date | 2017-04-03 |
Last Update Date | 2017-04-03 |