| NPI | 1417158775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE SANDERS Supervisor 337-623-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 1621676) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |