| NPI | 1124164306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA SYDNEY Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-08-03 |