| NPI | 1124481791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAMONICA ANTONETTE HODGES Owner/Administrator 662-820-7780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 901388) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-04-01 |