| NPI | 1174036578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN JEFFERSON DAWSON Mco 509-222-1275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2025-04-16 |