| NPI | 1053861641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN VINCENT GOVERNALE Practice Manager / Vice President 336-497-5701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC C010334) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2017-01-23 |