| NPI | 1033354840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | G BROOKS Administrator 910-891-7767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 103575) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2010-09-08 |