| NPI | 1033553862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA COLE LENNERT Manager 910-251-9944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: VA 0102203024) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2013-07-30 |