| NPI | 1033186333 |
|---|---|
| Other Name | TRI LAKES PEDIATRIC CLINIC |
| Entity Type | Organization |
| Authorized Contact | JENNY HERRON Hmpn 662-563-5611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2013-04-23 |