| NPI | 1902905649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA G VAN DE BOVENKAMP Director Of Administration 910-790-9949 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine Adolescent Medicine |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-10-28 |