| NPI | 1154386597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARNELL W DAVIS Executive Director 870-543-2380 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-07-20 |