| NPI | 1316202948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIDRA A BLANKS Owner 910-762-1070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NC 2006-00621) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-26 |