| NPI | 1376195727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. NOLAN Office Manager 601-376-9322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2021-07-01 |