| NPI | 1740437839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA D TIDWELL Office Manager 318-340-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 018486) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2008-08-20 |