| NPI | 1992026892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMA LEE LOCKLEAR Manager, Member/Owner 910-521-4464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC MHL-078-254) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2010-06-15 |