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Organization
GR VITO-BROOKDALE FOOT CLINIC
Active
Organization
GR VITO-BROOKDALE FOOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE VITO (SOLE MEMBER)
(336) 618-6961
Entity
Organization
Contact information
Practice address
533 BROOKDALE DR, STATESVILLE, NC 28677-4107
(336) 618-6961
Mailing address
PO BOX 24561, WINSTON SALEM, NC 27114-4561
(336) 618-6961
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
330
NC
Other
Enumeration date
05/12/2014
Last updated
05/12/2014
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