| NPI | 1205360450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER MARIE DAVIS Physician Assistant 704-277-1603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 8322) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2017-04-14 |