| NPI | 1740448653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA YOUNG BROCK Office Administrator 601-684-3210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS 7285) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2008-07-01 |