| NPI | 1740582212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRIA DIXON Administrator 252-353-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC MHL-074-163) |
| Additional Taxonomies | 251S00000X (Licence: NC MHL-054-145) |
| 251S00000X (Licence: NC MHL-025-018) | |
| 251S00000X (Licence: NC MHL-025-220) | |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2010-12-03 |