| NPI | 1760093025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI LYNN ROSS Owner 251-979-9825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2024-03-07 |