| NPI | 1710215256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE C BROWN Practice Administrator 704-896-9830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 9501464) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2009-11-20 |