| NPI | 1992010094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY ALAN CLARKE Owner 910-642-2230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 101710) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2010-08-12 |