| NPI | 1407541915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTAL HILLIE Owner 662-262-8441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261Q00000X | |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-10 |