| NPI | 1497705446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE MICHAEL COCKRELL President 662-301-1128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS m17248) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-08-22 |