| NPI | 1457604803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA MCLAUGHLIN Practice Administrator 251-625-6896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: AL 612818) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |