| NPI | 1528459526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL CARLISLE Owner 601-757-5791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 15093) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |