| NPI | 1922484500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA NICHOLS Program Director 318-239-3890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA 5905) |
| Additional Taxonomies | 251S00000X (Licence: LA 5132) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |