| NPI | 1912099805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD A MANCILLA Chief Operations Officer 601-352-5663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |