NPI | 1376716373 |
---|---|
Entity Type | Organization |
Authorized Contact | CHERILYNNE TONI COTTLES Owner 318-238-5900 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: 16920) |
Additional Taxonomies | 302R00000X Health Maintenance Organization |
Enumeration Date | 2008-04-10 |
Last Update Date | 2008-04-10 |