NPI | 1033258090 |
---|---|
Entity Type | Organization |
Authorized Contact | JUDY JORDAN Administrator 318-992-6217 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA ADC2324) |
Enumeration Date | 2007-02-06 |
Last Update Date | 2020-08-22 |