| NPI | 1295174555 |
|---|---|
| Former Legal Business Name | GARDEN ANGLES |
| Entity Type | Organization |
| Authorized Contact | ALLIE G NDIAYE CEO 662-289-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 7862) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2013-06-20 |