| NPI | 1578106621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER W IVES Managing Partner/Owner 251-928-8804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2024-01-08 |