| NPI | 1366499576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN L. HERZOG President 662-846-6034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 09800) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-08-22 |