| NPI | 1669687844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA R JOHNSON Account/Claims Coordinator 318-323-9433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD.010638) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2011-03-22 |