| NPI | 1821236415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON STEWART Executive Administrator 318-512-2304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2009-02-04 |