| NPI | 1467810143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM RODMAN WARREN Owner 336-724-5055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 4966) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |