| NPI | 1902054679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE DAVID MCNALLY Owner 228-896-5195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 11462) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2013-07-19 |