| NPI | 1922876960 |
|---|---|
| Doing Business As | INDEPENDENCE FAMILY CLINIC LLC |
| Entity Type | Organization |
| Authorized Contact | BRYAN DALE TATE Manager 985-878-4183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2023-12-19 |