| NPI | 1518149723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWERY MONTGOMERY Interim Administrator 662-834-1321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: MS 11-199-S-2) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2007-11-29 |