| NPI | 1023488657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANETTE STEWART Owner 601-441-8380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 1232) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2015-09-24 |