| NPI | 1811098866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE FELICE BLANCO Clinic Admin 601-364-1132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-10-07 |