| NPI | 1962970582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETATIA VANCE-NORRIS Owner 318-686-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2021-10-22 |