| NPI | 1124471131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LYNN OSTRANDER Office Manger 662-322-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MS 28794) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2016-07-14 |