Provider First Line Business Practice Location Address:
1122 E MAIN ST
Provider Second Line Business Practice Location Address:
NESHOBA PEDIATRICS SUITE 6
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39350-2348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-656-9900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006