| NPI | 1013286533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD RAY BONNER Owner 601-421-4808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MS 960070) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |