| NPI | 1699067959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY MONDAY Admin 601-296-2552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2011-05-04 |