| NPI | 1497299440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY STANETRICE WILSON Family Nurse Practitioner/Owner 754-224-9512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2017-05-10 |