| NPI | 1508360413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY RAY BIBB CEO 870-994-7301 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2022-05-26 |