NPI | 1629393491 |
---|---|
Entity Type | Organization |
Authorized Contact | TANYA MONIQUE OSWALD Owner 601-914-0732 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 18863) |
Enumeration Date | 2010-04-05 |
Last Update Date | 2010-04-05 |