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478 Williamson Road Ste B Mooresville NC 28117-9109 | |
| (704) 662-3627 | |
| (704) 662-3229 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 478 Williamson Road, Mooresville, North Carolina |
| Authorized Official Name and Position | Daniel L. Wiens (SENIOR VICE PRESIDENT) |
| Authorized Official Contact | 7043550648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 602124 Charlotte NC 28260-2124 Ph: (704) 662-3627 | 478 Williamson Road Ste B Mooresville NC 28117-9109 Ph: (704) 662-3627 |
| NPI Number | 1275781726 |
|---|---|
| Provider Enumeration Date | 09/08/2008 |
| Last Update Date | 09/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275781726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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