| NPI | 1700131562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVASTIAN GLENN Board Vice Chair 336-391-1097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2017-12-21 |