| NPI | 1699233916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CSQSHUNDRA D COX Owner 662-686-5017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2024-08-08 |