| NPI | 1659402006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATOSHA S MESSENGER Administrator 731-659-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-06-07 |