| NPI | 1104154988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNELIUS S OKONKWO Director 704-867-8855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: NC 200100074) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2010-02-05 |