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1598533275
LIFESOURCE PRIME INC
WILMINGTON, NC
NPI
1598533275
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Entity Type
Organization
Authorized Contact
PEGGY BADDOUR
CEO
910-742-9243
Organization Subpart ?
No
Primary Taxonomy
207Q00000X Family Medicine
Enumeration Date
2023-12-13
Last Update Date
2023-12-27
Business Address
LIFESOURCE PRIME INC
3205 RANDALL PKWY STE 105
WILMINGTON, NC 28403-2565
Phone number: 910-742-9243
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Mailing Address
LIFESOURCE PRIME INC
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-338-2882
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