| NPI | 1205024452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD H. RUSSELL Owner/Physician 662-534-2486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 208D00000X) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-12 |