| NPI | 1568800688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE COLBERT Business Manager 662-332-8848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS 14161) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |