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Individual

MR. MICHEAL THOMAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DIRECTOR

Contact information

Practice address
216 NORTH AVE, INDIANOLA, MS 38751-2131
(662) 336-8087
Mailing address
216 NORTH AVE, INDIANOLA, MS 38751-2131
(662) 336-8087

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
800064763
MS

Other

Enumeration date
06/15/2014
Last updated
06/15/2014
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