NPI | 1790748960 |
---|---|
Entity Type | Organization |
Authorized Contact | TERESA BURKETT Office Supervisor 910-219-4070 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 9901455) |
Enumeration Date | 2006-04-10 |
Last Update Date | 2014-08-19 |