| NPI | 1457413999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY E STOGNER CFO 910-895-6042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 26479) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1885) |
| 111N00000X Chiropractor (Licence: NC 1825) | |
| 208D00000X General Practice (Licence: NC 26678) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2008-09-05 |