| NPI | 1104235332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY WELLS President 501-202-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2015-09-18 |