| NPI | 1881691194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWARRENT LEE BRANTLEY President 318-840-9074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: LA 5CF64) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2025-02-05 |