| NPI | 1982958302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY L FENDER Adminstrator 601-947-8181 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2019-10-14 |