| NPI | 1154497105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLYN MARTIN Office Manager 251-928-1191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 173000000X Legal Medicine |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-04-12 |