| NPI | 1215191481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDA SCOTT WASHINGTON Director 318-793-8453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 10531) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2008-07-16 |