| NPI | 1184459661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LUCAS Np 910-622-0952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2025-06-03 |