| NPI | 1194276303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA KOHLIEM Owner/Operator 662-269-3870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS R875837) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2017-07-10 |