| NPI | 1407078165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERIK LEE ABNEY Owner 919-608-5267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC MHLO32370) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |