| NPI | 1891517512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA WOODARD Owner 225-261-4493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2024-10-25 |
| Last Update Date | 2025-01-14 |