| NPI | 1114161247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA LEE CLARK Manager 910-217-2941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 5204232) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2009-04-20 |