| NPI | 1447443379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANCI S SHAW Executive Director 337-236-5575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: LA 1522608) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2007-08-23 |