| NPI | 1760859193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN SMITH Clinical Pharmacy Director 336-645-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2015-09-02 |