| 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 |