| NPI | 1770548745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN A VAN RAVESTEYN Physician Owner 704-262-7901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9701631) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-08-22 |