NPI | 1447458385 |
---|---|
Entity Type | Organization |
Authorized Contact | GALE M DEAN Executive Driector 318-671-8131 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA PCA10802) |
Enumeration Date | 2007-07-03 |
Last Update Date | 2020-08-22 |