| NPI | 1689952335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELICIA POE Owner 662-303-9830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MS 1174) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |