| NPI | 1487118733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA LATASHA SHEPARD Fnp/Administrator 662-545-4674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2024-01-17 |