Provider First Line Business Practice Location Address:
2500 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE DIVISION OF GERIATRICS
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-5610
Provider Business Practice Location Address Fax Number:
601-984-5783
Provider Enumeration Date:
11/30/2006