| NPI | 1841691615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUKWUEMEKA EZEUME Medical Director 662-321-7899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 23325) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-12-03 |