| NPI | 1316314396 |
|---|---|
| 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) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2016-10-12 |