| NPI | 1487800520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL MANNING President 601-707-7026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 202K00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MS 13190) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2021-02-24 |