| NPI | 1740293257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY FENDER Administrator 601-947-8181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2019-11-07 |