NPI | 1376854083 |
---|---|
Entity Type | Organization |
Authorized Contact | WALTER EZEIGBO Owner/CEO 336-940-2659 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
Enumeration Date | 2010-06-28 |
Last Update Date | 2010-11-05 |