| NPI | 1003814104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AURELIA TAYLOR Cheif Executive Officer 662-624-4292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-06-01 |