| NPI | 1811178577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN J BOLTON President/Physician 662-869-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 16344) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2014-01-10 |