| NPI | 1790760692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA LAWMAN Clinic Administrator 662-844-5344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2026-03-19 |