| NPI | 1295090009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINNAMON FOSTER Sole Member 662-473-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS R872547) |
| Enumeration Date | 2012-07-08 |
| Last Update Date | 2022-04-05 |