| NPI | 1710179395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY DECENA Office Manager 228-863-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 12792) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2007-08-16 |