| NPI | 1578661633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA C HICKS Office Manager 662-843-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MS 80066) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-01-23 |