| NPI | 1285094953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTAIN LEE PETERSEN Owner 910-200-8806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: NC 317) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |