NPI | 1437514270 |
---|---|
Entity Type | Organization |
Authorized Contact | TEMPESTT O STANTON Owner/Supervisor 251-366-7366 |
Organization Subpart ? | No |
Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: AL 101581) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: AL 101581) |
Enumeration Date | 2015-12-21 |
Last Update Date | 2015-12-21 |