| NPI | 1215372594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTTHA L COPPAGE Vice President 337-364-2383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 022088) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2013-05-06 |