| NPI | 1760077481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY G CHAPMAN CFO 662-224-8951 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2022-04-21 |