| NPI | 1558613505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY BURTON Administrator 662-588-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS none required) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |