| NPI | 1275780181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA G GODDARD Office Mgr 337-824-2901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 1430) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-09-25 |