| NPI | 1790001154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA LIN HARRIS Owner 910-605-6697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: AZ 42673) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2025-06-09 |