| NPI | 1336463454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ROBERT VAN GIESEN Owner 252-338-3206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NC 1224) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |