| NPI | 1962995860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY MCDONALD Billing Manager 228-863-1132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS M8723) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |