| NPI | 1174904239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE WALDROP Owner 662-638-3677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 202K00000X Phlebology (Licence: MS 20317) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MS 20317) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2015-06-23 |