| NPI | 1720550940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TISHA RAE SMITH Practice Manager 252-728-5737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2022-02-24 |