| NPI | 1316320211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA PENCE Practice Manager 980-212-6540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NC 5007682) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-09 |