| NPI | 1902933153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK HINES Administrator 336-972-1892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NC FCL034071) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-08-30 |