| NPI | 1700656303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY RAY BIBB CEO 870-219-3978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-01-04 |