| NPI | 1629411731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE WALL Practice Manager 251-243-7058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 22050) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2024-05-15 |