| NPI | 1376576884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN R SCHAEFFER Md Owner 662-349-1959 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MS 14992) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2012-09-19 |