| NPI | 1215205539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY EJINKONYE AGBAFE-MOSLEY Medical Director 910-799-5452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-01999) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NC 179288) |
| 261QP2300X Clinic/Center, Primary Care (Licence: NC 2009-01999) | |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2018-07-17 |