| NPI | 1497297311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL J HIBBERT Vice President Co Owner 601-420-4001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS A2573) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |