| NPI | 1154545952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANETTE GRACE BAROWSKY Practice Administrator 910-592-5379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: NC 200001330969) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2009-10-01 |