| NPI | 1538369160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN F. ANGLE Owner 225-926-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 935) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2007-07-26 |