| NPI | 1861930802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY HERNANDEZ HARVEY Owner/Director 910-978-0663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 260000648) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2017-02-10 |