| NPI | 1659551786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH AVERY VICTOR Administor 985-651-7887 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: LA 9580) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |