| NPI | 1841027646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON REECE Executive Director 662-293-7678 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2025-07-31 |