| NPI | 1104010156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JO-ANN CUPID CEO 704-971-4445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200301427) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200301427) |
| 207Q00000X Family Medicine (Licence: SC 21652) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2015-02-05 |