| 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 |