| NPI | 1124291166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER G TANS Owner 704-341-0016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 5189) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2008-04-10 |