| NPI | 1689786261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMERSON WALLACE President 662-840-8010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MS C02648) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-07-21 |