| NPI | 1417974064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE A BLELLOCH Managing Pa 919-870-8845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 132522) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-03-25 |