| NPI | 1508254707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICCO FOX Business Manager 704-523-5775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 11324) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2014-12-23 |