| NPI | 1396123584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVA WASHINGTON Counselor 336-312-7761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC 20337) |
| Additional Taxonomies | 251S00000X (Licence: NC A10756) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |