| NPI | 1528182813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNESTINE BONEY MOORE Administrator 910-289-7183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC FCL-031-005) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |