| NPI | 1417113267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA V SNEED-MATTHEWS Chief Administrator 318-213-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 20081) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2008-07-31 |