| NPI | 1689761546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BASHORE Administrator 704-920-7027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NC AS0070) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NC 060202) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2015-06-09 |