| NPI | 1013144732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JANE BELFIE Counselor 318-443-9246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 1415) |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2009-06-20 |