| NPI | 1710437074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONGILIA Q WALTON Owner 662-539-7383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R871879) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2017-02-07 |