| NPI | 1811176076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA FRAZIER Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: NC MLH-092-668) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2008-03-11 |