| NPI | 1891150629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY JO ALEXANDER Owner 601-590-1045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS R687693) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-22 |