| NPI | 1386912723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGOT PETERS Director 251-865-1852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2024-07-23 |