| NPI | 1629452123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN NORRIS Owner 251-341-7295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2019-09-09 |