NPI | 1922247329 |
---|---|
Entity Type | Organization |
Authorized Contact | SAMANTHA ANN ROACH Administrator 225-291-3123 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA PC0007839) |
Enumeration Date | 2009-02-10 |
Last Update Date | 2009-02-10 |