| NPI | 1073004891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY RAY BIBB CEO 870-994-7301 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2020-02-03 |