| NPI | 1073759502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIK S RICHARDSON Owner 662-236-1927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 17356) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2010-01-11 |