| NPI | 1194968719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED SURGEON CEO 910-733-0617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2009-04-13 |