| NPI | 1164129755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA S COCKRELL Owner/Operator 662-630-5001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-02-14 |