| NPI | 1306378005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRYSTAL PIKE Authorized Official 984-219-3916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 225780) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2017-03-31 |