| NPI | 1841311859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN F MITCHELL Owner 985-223-2429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA PCA 11179) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |