| NPI | 1982629705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD D CLARK Medical Director 601-732-8612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health (Licence: MS 03575) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-01-14 |