| NPI | 1912385261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENETTA DENISE MACMILLAN Manager Clinical Operation 251-434-3661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: AL 2530) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |