NPI | 1871767186 |
---|---|
Entity Type | Organization |
Authorized Contact | JAMES J DERBES Owner 985-626-7795 |
Organization Subpart ? | Yes |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 1080) |
Enumeration Date | 2008-04-17 |
Last Update Date | 2008-10-14 |