| NPI | 1629019088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALIA RENEE PAIGE Practice Administrator 704-341-1103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 120015) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-08-22 |