| NPI | 1215502232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOSHIE LILLEY Owner 662-387-7167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2021-05-21 |