| NPI | 1699881615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK BERYL HANMER Member / Manager 910-276-1775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 124239) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2010-07-20 |