| NPI | 1235374729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHUNTA SHARLAN PRINGLE Program Director 318-255-1090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 15139) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |