| NPI | 1891724936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHASE C SOONG CEO/Administrator 318-807-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: LA 142) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-08-22 |