| NPI | 1740798503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA L DIAL Owner 601-953-2410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: MS 18187) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 18187) |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2018-01-15 |