| NPI | 1538110713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ELLIS Office Manager 662-680-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 25C0001058) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2008-10-10 |