| NPI | 1447225503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA FERRELL Administrator 662-349-0910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 026) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2010-12-20 |