| NPI | 1235513714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEKORY JUANTE JEFFERSON President/CEO 601-316-0156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MS R603643) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2015-07-15 |