| NPI | 1942486535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN STAGE Owner 318-322-3520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: LA 012235) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2015-06-29 |