| NPI | 1154360501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON SMITH Administrator 228-818-0563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 002) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2020-08-22 |