| NPI | 1548457559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON WHITE Physican 318-443-9400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 025398) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2007-10-26 |