| NPI | 1710193396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSIE D HAYES President 910-602-2769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: DOES NOT APPLY) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |