| NPI | 1962835942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD FRICK Owner 225-387-3030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2021-02-22 |