| NPI | 1518359165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEANN CRAIG Owner 225-252-7633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 2203782281) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2015-02-19 |