| NPI | 1205137304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT L MOORE Owner 601-307-2450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS MS18036) |
| Enumeration Date | 2010-11-06 |
| Last Update Date | 2013-04-18 |