Provider First Line Business Practice Location Address:
2500 N. STATE ST.
Provider Second Line Business Practice Location Address:
DEPT OF ORAL-MAXILLOFACIAL SURGERY AND PATHOLOGY
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-6090
Provider Business Practice Location Address Fax Number:
601-984-4949
Provider Enumeration Date:
07/25/2018