| NPI | 1891907440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES W CAMPBELL Owner 662-834-1722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 04488) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2015-06-25 |