| 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 |