| NPI | 1689605826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BERGIN Administrator 601-369-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 025) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-04-18 |