| NPI | 1861547085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENN PEMBERTON STINNETT Billing Coordinator 866-254-7180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 200001253733) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2014-12-19 |