| NPI | 1366003436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISOTPHER WILLIAM BLACKWELL Owner, Provider 601-377-1975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2021-03-15 |