| NPI | 1699918417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA RAY PATTERSON Owner 225-993-0766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 376K00000X) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |