| NPI | 1679826945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE M. SOTOLONGO Owner 601-206-9101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2023-01-13 |