| NPI | 1184808594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY JOHNSON Owner 910-824-1155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: HAL043003) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2007-12-20 |