| NPI | 1184941676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD FLOYD ALDRIDGE Manager 228-818-5155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 11483) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2010-04-23 |