| |
1400 Tulip Dr Gastonia NC 28052-1873 | |
(704) 868-5703 | |
(704) 868-5787 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 1400 Tulip Dr, Gastonia, North Carolina |
Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 1400 Tulip Dr Gastonia NC 28052-1873 Ph: (704) 868-5703 |
NPI Number | 1568137719 |
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Provider Enumeration Date | 08/10/2021 |
Last Update Date | 08/24/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568137719 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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