NPI | 1700039062 |
---|---|
Doing Business As | BERNADINE WILSON |
Entity Type | Organization |
Authorized Contact | BERNADINE K WILSON Owener 985-237-2071 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 94095423) |
Enumeration Date | 2008-10-30 |
Last Update Date | 2008-10-30 |