| NPI | 1508999871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD BLAKE SMITH Owner 662-234-1731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-07-21 |