| NPI | 1902018070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELLIE MCCALLUM Office Manager 910-417-3456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NC 2007-00491) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |