| NPI | 1710130299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC BERNARD MITCHELL Director Of Operations 910-223-0120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2008-10-29 |