| NPI | 1588620157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA VAN DE BOVENKAMP Medical Office Administrator 910-790-9949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2010-10-27 |