| NPI | 1790717080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMIN CHAPMAN CEO 601-362-5321 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-04-25 |