| NPI | 1821758293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONICA ANGEL LOGAN CEO 336-317-9633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2024-06-27 |