| NPI | 1730424177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL BLOSSOM MCGOWAN-ROBINSON Owner 704-310-8893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 185683) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2012-12-11 |