| NPI | 1093805483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAVONDELL RISOTTO STALLINGS Executive Director 336-378-0109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC 8300896) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-05-15 |