| NPI | 1437551090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CLARK RACHAL Whnp 318-876-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA AP06238) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2014-09-25 |