| NPI | 1467680546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEMENE QUINN Owner 601-956-5924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA A63958) |
| Additional Taxonomies | 261Q00000X (Licence: MS 18070) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2009-06-26 |