| NPI | 1578972139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN THOMAS Operational Director 252-425-5764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2021-08-30 |