| NPI | 1073727863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY A SCOTT Owner 318-255-9105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA 7174) |
| Additional Taxonomies | 251S00000X (Licence: LA 7185) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |