| NPI | 1104044494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA LEE UNDERWOOD Office Manager 662-890-3234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MS 13955) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |