| NPI | 1205146719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE VOULTERS President 228-297-9207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: MS 15432) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2022-07-18 |