| NPI | 1710157912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW BLANE CARPENTER Owner/Manager 704-542-0501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NC 1179) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |