| NPI | 1083134092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELVIN MCALLISTER CEO 910-488-6118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-10-26 |