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 |