| NPI | 1104025857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATSY D JOHNSON Accounting Director 318-671-8131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA PCA10803) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2007-07-13 |