| NPI | 1083893937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY MURDOCK COO 228-818-1195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2022-11-02 |