| NPI | 1447271713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA WALKER Manager 662-328-1012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: MS 25C0001046) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-06-22 |