| NPI | 1922017391 |
|---|---|
| Doing Business As | MEDICAL GROUP OF WAXHAW |
| Entity Type | Organization |
| Authorized Contact | DANIEL L WIENS Senior Vice President 704-355-0648 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-12-02 |