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 |