| NPI | 1992102073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN JAMES CFO 229-723-2660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-04-06 |