| NPI | 1568794279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIVARAMA K KOTIKALAPUDI Owner 601-795-4969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: MS 18593) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2010-02-04 |