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Individual
MR. MOORE BYNUM
Active
Individual
MR. MOORE BYNUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-033-054
NC
Other
Enumeration date
01/22/2008
Last updated
01/22/2008
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