| NPI | 1386895159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA LAVERNE MACKLIN Owner; Qualified Professional 252-541-1576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC C200815700098) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2008-10-09 |