| NPI | 1740059161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY SOPHIA BENNETT Family Nurse Practitioner 662-279-1056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2023-12-27 |
| Last Update Date | 2024-02-12 |