| NPI | 1841540663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK GOSLEE Administrator 910-630-3041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X (Licence: NC MHL - 026 - 859) |
| Additional Taxonomies | 251C00000X (Licence: NC MHL - 026 - 858) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2012-09-19 |