Heavenly Palace Adult Center, Inc.
NPI #1790954592 in Greenville, Mississippi
Provider Information
- NPI Number
- 1790954592
- Entity Type
- Organization
- Organization Name
- Heavenly Palace Adult Center, Inc.
- Primary Specialty
- Preferred Provider Organization
- Enumeration Date
- Feb 26, 2008
- Last Updated
- Feb 26, 2008
Practice Location
- Address
- 1654 HIGHWAY 1 N
- City
- Greenville
- State
- Mississippi
- ZIP Code
- 38701-0000
- Phone
- (662) 378-7262
Authorized Official
- Name
- MR. PATRICK JACKSON
- Title
- PRESIDENT
- Phone
- (662) 378-7262
Specialties & Taxonomy Codes
| Specialty |
|---|
| Preferred Provider Organization |
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