| NPI | 1508057076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN FAIRMAN CEO 662-741-2358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2010-11-23 |