| NPI | 1972043511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Administrator 318-212-8951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2017-03-01 |