| 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 |