NPI | 1114184405 |
---|---|
Entity Type | Organization |
Authorized Contact | RODNEY JACKSON CEO 225-644-7613 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 15021) |
Enumeration Date | 2008-05-22 |
Last Update Date | 2008-05-22 |