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Organization

MB COSTELLO ENTERPRISES LLC

Active
Other names
PCA Pain Care Center
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRUCE COSTELLO DC (FRANCHISEE)
(404) 354-3111
Entity
Organization

Contact information

Practice address
1501 LAKELAND DR STE 251, JACKSON, MS 39216-4848
(601) 321-8000
(601) 321-8001
Mailing address
1501 LAKELAND DR, SUITE 251, JACKSON, MS 39216-4834
(601) 320-8000
(601) 320-8001

Taxonomy

Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary

Other

Enumeration date
05/13/2011
Last updated
09/29/2011
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