| NPI | 1508385428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY M POPE Owner 336-710-1949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 5006312) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management |
| 291900000X Military Clinical Medical Laboratory | |
| 291U00000X Clinical Medical Laboratory | |
| 292200000X Dental Laboratory | |
| 293D00000X Physiological Laboratory | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2022-07-21 |