| NPI | 1013177922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY FRANCES JACKSON Office Coordinator 704-633-7117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC 8556) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2008-06-13 |