| NPI | 1831132562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN C. BERRY Owner 662-624-2466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R659975) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-08-22 |