| NPI | 1104222959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA HOLMES Adminstrator 318-574-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 1882224) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |