| NPI | 1669691861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEYMOUR SEYMOUR CEO 662-741-2151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: GA 052419) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2008-08-01 |