Provider First Line Business Practice Location Address:
945 HWY 42
Provider Second Line Business Practice Location Address:
SOUTH PRENTISS SHOPPING CENTER
Provider Business Practice Location Address City Name:
PRENTISS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-792-4467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2006