Organization
IMANI COMMUNITY OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA DUNCAN (BILLER)
(601) 878-6945
Entity
Organization
Contact information
Practice address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Mailing address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
MS
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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