| NPI | 1164949210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA LEE JARVIS Organizer/Member 980-533-0993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NC 5000468) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2017-08-29 |