| NPI | 1083767271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUNICE CRUMP Owner Manager 662-369-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 8243) |
| 208D00000X General Practice (Licence: MS R857916) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2019-10-21 |