| NPI | 1144548181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI BABETTE JOHNSON Administrator 662-665-2818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS r605972) |
| Enumeration Date | 2010-05-15 |
| Last Update Date | 2010-05-15 |