| NPI | 1962674739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI G FERGUSON Clinic Administrator 662-234-0424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 13319) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2009-06-24 |