| NPI | 1255531885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH OSITA EDMUNDS Medical Director/President 662-349-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 14060) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 14060) |
| Enumeration Date | 2007-07-22 |
| Last Update Date | 2007-07-22 |