| NPI | 1609990886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA T. TONEY President 985-781-1041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: LA 9578) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: LA 12549) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |