| NPI | 1417364480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRASHA BLACK Clinical Director 704-596-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NC P009049) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |