| NPI | 1114245164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL C REED Owner 985-542-1770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 1301) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2010-05-13 |