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Organization

WK AND THE ASTHMA-ALLERGY CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization

Contact information

Practice address
2300 HOSPITAL DR, SUITE 345, BOSSIER CITY, LA 71111-2394
(318) 212-7780
(318) 212-7785
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8946
(318) 212-4153

Taxonomy

Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary

Other

Enumeration date
07/14/2010
Last updated
07/21/2010
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