| NPI | 1700324613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA SHUNTRELL JORDAN Community Support Specialist 601-529-0910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2017-02-10 |