| NPI | 1013624394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL M ROGERS Family Nurse Practitioner 910-801-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |