| NPI | 1073799003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY DESORMEAU GREEN Director 704-633-9747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 175133) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2008-01-22 |