| NPI | 1851538342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA ANN ROACH Administrator 225-291-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA PCA 15172) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2009-02-01 |