| NPI | 1558545210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA PHARR Executive Director 662-842-6776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 1000) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2007-12-18 |