| NPI | 1184080426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN POE Office Manager 601-427-5775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: MS OT2806) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2015-12-31 |