| NPI | 1740434141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEXTER LAMONT JONES Executive Director 704-865-8533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2008-11-11 |