| NPI | 1518793025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEA JEANINE WALTON Rsc Manager 704-316-6081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-10-14 |