| NPI | 1255773792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY SHERRELL COLEMAN Owner 252-230-0631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 1207282) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2013-07-25 |