| NPI | 1811433444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE LAWING Program Director 704-985-1189 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: TN I000000021371) |
| Additional Taxonomies | 251S00000X (Licence: TN I000000019328) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2018-03-14 |