Provider First Line Business Practice Location Address:
2500 N STATE ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-643-6284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2011