| NPI | 1194215681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHERUN MICHELLE BROOKS Owner/Operator Sole Mbr 662-331-1497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-11-09 |