| NPI | 1982026282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DISHEMA S. SHULER Clinical Director 336-456-9907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC C008432) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2020-10-29 |