| NPI | 1528707585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA STEPHENS Family Nurse Practitioner 662-571-0916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QI0500X Clinic/Center, Infusion Therapy |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-05-29 |
| Last Update Date | 2022-05-29 |