| NPI | 1629417324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE J FRYERY Director Of Clinic Operations 662-446-1972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2017-01-19 |