| NPI | 1972689321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH LEE HINES President 100 Percent Stockholder 662-455-1442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 08354) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2007-11-07 |