| NPI | 1437870573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY MARLIN WOMACK VP 662-686-3881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |