| NPI | 1871652024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEYMOUR MITCHELL CEO 662-741-2151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MS 17375) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |