| NPI | 1356678858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN TRENESE-WILLIAMS JONES Director 251-621-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2009-11-04 |