| 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 |