| NPI | 1174042485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONG WHAN KIM Owner/Provider 910-876-7301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 200101455) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2022-07-21 |