| NPI | 1003033473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GALE M DEAN Ex Director 318-671-8131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA pca9546) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |