| NPI | 1245244094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN SPARE Executive Vice President 336-718-2046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-08-14 |