| NPI | 1033370580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PORTIA F TRAVIS Nurse Practitioner 662-751-8566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS R800172) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2008-06-18 |