Organization
PREMIERE SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE WEST (EXECUTIVE DIRECTOR)
(919) 270-0821
Entity
Organization
Contact information
Practice address
2245 GARNER RD, RALEIGH, NC 27610-4609
(919) 270-0821
Mailing address
2245 GARNER RD, RALEIGH, NC 27610-4609
(919) 270-0821
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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