| NPI | 1790089324 |
|---|---|
| Doing Business As | MEDICAL SPARK |
| Entity Type | Organization |
| Authorized Contact | CHIP SLACK CEO 601-594-7107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2010-12-22 |