| NPI | 1104848787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEYMOUR MITCHELL CEO 662-741-2151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MS 18547) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-08-22 |