| NPI | 1770525057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRIMAUS WHEELER Chief Executive Officer 601-984-8467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MS 18106) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-05-15 |