| NPI | 1275780660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDOLPH SCOTT RUNNELS Owner 601-939-9778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 13960) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2008-08-27 |