| NPI | 1952579807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY R NIFONG Co Owner 336-784-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NC 88463) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2024-09-10 |