| NPI | 1427415918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD GRANT MARTIN Owner 318-469-9132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: LA 2032) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: LA 2032) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |