| NPI | 1013439736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE JEAN HODGE Owner 662-420-3264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS R858633) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2018-06-16 |