| NPI | 1518963123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE J CARNAHAN Office Manager 662-349-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2007-12-12 |