| NPI | 1205684776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA NICOLE GARDNER Administrator 662-816-3791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-05-09 |