| NPI | 1205180882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN D MCCOY Owner 662-258-7533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2022-02-16 |