| NPI | 1558670802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE GOSSETT Nurse Practioner 662-333-6387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS r687235) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2010-10-05 |