| NPI | 1104121839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA G JACOBS Owner 910-318-3557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: NC 25204) |
| Additional Taxonomies | 246XC2903X Spec/Tech, Cardiovascular, Vascular Specialist (Licence: NC 25204) |
| 2471S1302X Radiologic Technologist, Sonography (Licence: NC 25204) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2011-03-30 |