| NPI | 1174738520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY THOMPSON LATZ Sole Owner 704-662-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NC 34660) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-10-03 |