| NPI | 1699963520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE M SIMAAN President 336-632-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC 3030) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2007-10-04 |