| NPI | 1861558512 |
|---|---|
| Doing Business As | HEALTHSOURCE |
| Entity Type | Organization |
| Authorized Contact | ROOSEVELT JOHN SMITH Clinic Director 336-235-4022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NC 2930) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2009-11-19 |