| 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 |