| NPI | 1215451794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY R EASTERLING Owner 601-636-8184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MS 10687) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |