| NPI | 1063819472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONA DIANE BOSTICK Owner Operator 336-291-3622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L003817) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |