Individual
H CORNWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3005 WASHINGTON ST, VICKSBURG, MS 39180-4966
(601) 636-3273
Mailing address
3005 WASHINGTON ST, VICKSBURG, MS 39180-4966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
233-87
MS
Other
Enumeration date
06/24/2008
Last updated
06/24/2008
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