| NPI | 1568491728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL R BRUNT President 228-762-0713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 09811) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-08-22 |