| NPI | 1902053192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANCI S SHAW Executive Director 337-948-3194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA SIL 20008) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |