| NPI | 1497523625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ALLEN RIDDICK Practice Manager 919-734-4736 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QR1300X Clinic/Center Rural Health |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-19 |