| NPI | 1053699488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY MONDAY Billing Admin 601-296-2552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2011-08-03 |