| NPI | 1679298939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DAVIS COO 601-859-5213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2022-10-10 |