| NPI | 1659479210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL G. MATHERNE Owner/Solo 228-388-4862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 09445) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-12-08 |