| NPI | 1669008090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANITA KHALIL Executive Director 251-471-5277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-03-17 |