Organization
PURPOSE OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNA BURCH (EXECUTIVE DIRECTOR)
(704) 345-8825
Entity
Organization
Contact information
Practice address
2601 PALM AVE, CHARLOTTE, NC 28205-2239
(704) 345-8825
(704) 900-0787
Mailing address
2601 PALM AVE, CHARLOTTE, NC 28205-2239
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
03/30/2011
Last updated
03/30/2011
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