| NPI | 1306123294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIE B LANE Licensee 252-903-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: NC mhl-064-126) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2011-12-08 |