| NPI | 1043564735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE COLBERT Administrator 662-332-8848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 18512) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-07 |