| NPI | 1427487818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYL JOHNSON Agency Owner 704-373-7043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 8480713) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-11-06 |