| NPI | 1184961153 |
|---|---|
| Other Name | PETAL PRIMARY SCHOOL |
| Entity Type | Organization |
| Authorized Contact | GEROLDEAN DYSE CEO 601-545-8700 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2021-04-16 |