| NPI | 1528720653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEISHA HARRIS Credentialing Manager 336-355-9701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-06 |