| NPI | 1053577452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVONDA H PUGH CEO 252-794-1835 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2023-03-24 |