| NPI | 1710865803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUITTA R GREEN Chief Financial Officer 662-624-4292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |