| NPI | 1871310714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA DUPRE Owner 225-333-8303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |