| NPI | 1851713374 |
|---|---|
| Other Name | WELLNESS CTR. STUDENT BLUE |
| Entity Type | Organization |
| Authorized Contact | ANTHONY PHILADELPHIA Director 336-750-3274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-01-17 |