| NPI | 1821389529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDA WASHINGTON Executive Director 318-793-8453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA ADC10580) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-05-25 |