| NPI | 1144529983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT NEAL SUARES Owner 662-334-8557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MS 20731) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2019-11-14 |