| NPI | 1407875610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY ARLENE WATSON Practice Administrator 910-763-6251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 40206) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-02-01 |