| NPI | 1619359437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAVON STALLINGS Owner 252-695-8049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MD 8877445) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-06-29 |