| NPI | 1366837767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENITA L MOORE Director 228-297-5597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-16 |