Organization
DIBERVILLE MEDICAL SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONNIE ALI DO (PRESIDENT)
(228) 223-1927
Entity
Organization
Contact information
Practice address
3661 SANGANI BLVD, SUITE C, DIBERVILLE, MS 39540-8706
(228) 223-1927
Mailing address
PO BOX 1248, OCEAN SPRINGS, MS 39566-1248
(228) 223-1927
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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