| NPI | 1972803617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY A DE PONCEAU Office Manager 910-323-3183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 5004935) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2010-10-28 |