| NPI | 1417027921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA BRYAN Office Manager 662-620-1496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS C02970) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-12-20 |