| NPI | 1801662366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL MARS HOWERTON Sr VP Network Phys & Hscmo 336-716-1331 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |