| NPI | 1508237496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD PAVELOCK Owner 704-880-8665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 39460) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2015-10-17 |
| Last Update Date | 2015-10-17 |