| NPI | 1992190367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES D NUNNALLY CEO 662-224-8951 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-02 |