| NPI | 1609934272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA M JONES Office Manager 662-429-8802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MS M14539) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-08-22 |