| NPI | 1851681696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM J SCOTT Administrator 225-927-1607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 15438) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2011-04-13 |