| NPI | 1326045444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BRIAN HERTZOG Administrator 228-575-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 017) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2020-08-22 |