| NPI | 1891058210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK OLDPA MCCLAIN Owner/Administrator 704-713-9920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC FCL-060-123) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-08-10 |