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 |