| NPI | 1912476367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA COLLINS Credentialing Coordinator 336-768-6211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2018-11-15 |