| NPI | 1184736654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE JEAN ALLGOOD Vice President Of Corp 228-475-7877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 11525) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |