| NPI | 1285856633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THELMA KELLER JONES Director 225-383-7793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 12601) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: LA 12600) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |