| NPI | 1619175551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GALE M DEAN Executive Director 318-671-8131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA PCA9546) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2020-08-22 |