| NPI | 1164703880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH S MCNULTY CEO 662-285-9050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2014-02-26 |