| NPI | 1700611563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DETAVIA KENAN Owner 336-303-0587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-03 |