| NPI | 1932369535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE C WHITE CEO 318-425-2252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2008-06-17 |