| NPI | 1629248190 |
|---|---|
| Former Legal Business Name | LILLIAN CONVENIENT CARE |
| Entity Type | Organization |
| Authorized Contact | RADCLIFFE J COYLE Dr. / Owner 251-962-4362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: AL 6346) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-04-08 |