| NPI | 1093121196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH ETHRIDGE Administrator 228-297-0517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 022) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-09 |