| NPI | 1417347162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KITTY FOOSHEE Office Manager 662-534-5036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS R874900) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |