| NPI | 1386816700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIA J KIMMONS Speech Language Pathologist 662-349-2370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: MS S3061) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2010-11-16 |