| NPI | 1902906258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY MARLIN WOMACK VP Of Administration 662-686-4121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-07-21 |