| NPI | 1306726641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FREDERICK COOPER Scientific Director 332-495-8104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-09-05 |
| Last Update Date | 2025-09-08 |