| NPI | 1639177751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA E KELLY Insurance Representative 662-455-4523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-08-26 |