| NPI | 1689933764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRELL BERRY BOONE Owner 601-928-1871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 1063) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2012-05-10 |