| NPI | 1427309103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY BEAM Owner 704-300-2226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2012-09-22 |