| NPI | 1790954592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK JACKSON President 662-378-7262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 07186736) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-02-26 |