| NPI | 1942491428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE PORTER Accounts Receivable Coordinator 662-741-2151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-08-08 |