| NPI | 1275906638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANETT T WILLIAMS MIMS President CEO 919-654-7309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2015-11-06 |