| NPI | 1811136476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRE'SHAWNA WHITE Finance Director 336-283-9893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2023-07-07 |