| NPI | 1770840464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA LOUISE HOLLER CEO 337-213-2393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA MFT368) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |