| NPI | 1508393000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAJUANDRA K CHANDLER Manager/Owner 662-303-3743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 901379) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2018-06-16 |