| NPI | 1275673097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LYNN THORNTON Billing Manager 704-865-2755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NC 102847) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NC 009600205) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-02-28 |