| NPI | 1982989307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA GUIDRY Billing Supervisor 866-973-1043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: FL PTA22629) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |