| 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 |