| NPI | 1326353798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL N BLAYLOCK M.D. 662-332-7211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 04644) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2010-08-31 |