| NPI | 1902088453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LOUSTEAU Clinic Administrator 601-859-2611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 09015552) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2010-03-03 |