| NPI | 1164969036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY FOLGER SUMMERLIN Manager 336-755-6996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC 11015) |
| Additional Taxonomies | 251S00000X (Licence: NC LCAS-21026) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |