| NPI | 1619224144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKISHA D PURDIE Practice Manager 910-677-9488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2017-02-02 |