| NPI | 1992219190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARON LEGARDE Owner/Clinic Director 870-580-0999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: AR 16047) |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2017-11-27 |