| NPI | 1629428883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDT WOOD Owner 910-867-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2016-09-23 |