| NPI | 1386990430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMILLE H LITT Administrator 225-205-4960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 336) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2012-07-26 |