| NPI | 1770236051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANNEKU GARDNER Lpn 704-794-3178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-03-09 |