| NPI | 1235678715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA A MEADOWS Owner/Program Director 704-218-2128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |