| NPI | 1194358770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DON HOLLOMAN CEO 704-792-2203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-10-07 |