| NPI | 1801174230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON CHAMPION Administrator 228-467-4431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2011-08-02 |