NPI | 1285094953 |
---|---|
Entity Type | Organization |
Authorized Contact | KRISTAIN LEE PETERSEN Owner 910-200-8806 |
Organization Subpart ? | No |
Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NC 317) |
Enumeration Date | 2016-02-24 |
Last Update Date | 2016-02-24 |