| NPI | 1215358783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A. FAIRMAN Chief Executive Officer 662-741-8880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2016-06-22 |