| NPI | 1932349016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL PURCELL REYNOLDS Owner/Administrator 336-324-7931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NC FCL-079-071) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2009-03-02 |