| NPI | 1669918199 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | MAR'DOSHA PEEK Chief Executive Officer 318-771-7707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2017-01-08 |
| Last Update Date | 2023-06-23 |