NPI | 1679772347 |
---|---|
Entity Type | Organization |
Authorized Contact | TINA LUCE Office Manager 337-616-9948 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 08095R) |
Enumeration Date | 2007-07-13 |
Last Update Date | 2007-07-16 |