| NPI | 1730109240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRIAM SHATLEY Manager 601-992-7002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 14462) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |