| NPI | 1508656422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LEANN WIGLEY Np/Owner 228-493-0073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2025-05-22 |