| NPI | 1639621675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUNK A ELLIS Owner 228-474-2212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 17210) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2022-02-01 |