| NPI | 1427590801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGARET PROVOST Owner/Administrator 985-687-4703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2017-10-09 |