NPI | 1881691194 |
---|---|
Entity Type | Organization |
Authorized Contact | DEWARRENT LEE BRANTLEY CEO/ President 318-676-3762 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: LA 5CF64) |
Enumeration Date | 2005-06-30 |
Last Update Date | 2009-06-16 |