| NPI | 1992258255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD KIMBROUGH Director 662-377-5201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 901548) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |