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 |