| NPI | 1396886842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVONDA PUGH CEO 252-794-1835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| 174400000X Specialist | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-06-24 |