| NPI | 1558516955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBY HARRIS Owner 336-442-4706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: 305R00000X) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2008-11-26 |