| NPI | 1891790887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA JACKSON Administrator 662-293-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 012) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2020-08-22 |