| NPI | 1063767242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISAAC BLOUNT Manager 252-317-2006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 888465) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2012-07-13 |