| NPI | 1669646675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA S. LEARY Credentialing Services Administrato 336-547-0607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC 765) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |