| NPI | 1770338410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESTON HUMPHREYS COO 662-236-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |