| NPI | 1124046198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD PAVELOCK Owner 704-838-0516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2017-04-19 |