| NPI | 1417684135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER FORTIN Office Manager 910-483-4680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2024-06-25 |