| NPI | 1346326808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY GIBBS Office Manager 228-818-2801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MS 80130) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 80130) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2022-07-21 |