| NPI | 1235429648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN L MONTGOMERY Owner/Provider 601-790-9098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS R524174) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |