| NPI | 1124295670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERILYNNE TONI COTTLES Owner 318-238-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: LA 16920) |
| Additional Taxonomies | 251E00000X Home Health (Licence: LA 16920) |
| 302R00000X Health Maintenance Organization (Licence: LA 16920) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |