| NPI | 1659816858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN GILLUM Director Of Oversight & Management 318-629-3763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: LA MD.019455) |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2016-12-23 |