| NPI | 1770614406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDA WASHINGTON Director 318-793-8453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA RC10532) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |