Provider First Line Business Practice Location Address:
100 HOSPITAL ST
Provider Second Line Business Practice Location Address:
BAPTIST MEMORIAL HOSPITAL - ED
Provider Business Practice Location Address City Name:
BOONEVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38829-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-720-5404
Provider Business Practice Location Address Fax Number:
662-720-5450
Provider Enumeration Date:
05/05/2006