| NPI | 1790093094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA G VAN DE BOVENKAMP Director Of Administration 910-790-9949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L003170) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2010-09-21 |