| NPI | 1396733945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE OWEN Clinical Director 662-327-3773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 25C0001039) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2007-07-20 |