| NPI | 1073898227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM E. COLLINS Designated Principal 336-399-1112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: FL ME0040553) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2013-07-25 |