| NPI | 1992171060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM C ELLISON Revenue Cycle Manager 910-567-7065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2024-03-27 |