| NPI | 1871855379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK WILCOX CEO 910-327-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 20000007) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2012-06-11 |