| NPI | 1073071817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRONNIE JONES Director Of Operations 252-514-0057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2019-06-11 |