| NPI | 1649543802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIOVONNI SHERRILL Director/Owner 704-334-7858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC HC3385) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2012-03-08 |