| NPI | 1023404704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY ALBERT KELLY Mhpa, Ph.D 910-747-5215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: TN 1046352) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2015-04-09 |