| NPI | 1730146267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY L SPARKS Practice Administrator 252-443-5941 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 39290) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2015-03-25 |