Imani Community Out Reach Center
NPI #1295174555 in Kosciusko, Mississippi
Provider Information
- NPI Number
- 1295174555
- Entity Type
- Organization
- Organization Name
- Imani Community Out Reach Center
- Primary Specialty
- Preferred Provider Organization
- Enumeration Date
- Jun 20, 2013
- Last Updated
- Jun 20, 2013
Practice Location
- Address
- 301 E JEFFERSON ST
- City
- Kosciusko
- State
- Mississippi
- ZIP Code
- 39090-3719
- Phone
- (662) 289-7676
Authorized Official
- Name
- MS. ALLIE G NDIAYE I
- Title
- CEO
- Phone
- (662) 289-7676
Specialties & Taxonomy Codes
| Specialty |
|---|
| Preferred Provider Organization |
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