| 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 |