| NPI | 1689141822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARI WOODY Practice Administrator 251-263-4991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2018-11-06 |