| NPI | 1639624034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLIS H CRITTENDON Manager 704-439-7498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NC MHL-060-1317) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2016-08-16 |