| NPI | 1952705386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN WESLEY TYSON M 229-386-2534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology |
| 225700000X Massage Therapist | |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-14 |