| NPI | 1720121395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIA DENIESE BLACKMON Medical Director 251-438-7170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: AL 1-073404) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-08-22 |