| NPI | 1144418609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA JEAN FITTS Owner 662-236-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MS 17111) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2010-03-17 |