| NPI | 1861640716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY MARSHALL Treasurer 318-342-0003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 15091) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |