| NPI | 1881894681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY MICHELLE WILSON Program Director 318-343-3821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 7285) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-19 |