| NPI | 1992751374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGO J ILLOBRE Business Office Supervisor 910-343-9991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 41057) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 41057) |
| 2085B0100X Radiology, Body Imaging | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2009-11-11 |