| NPI | 1386984375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFANIE L. RUDD Owner 336-907-7268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 281050) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2013-02-27 |