Individual
GRACE GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4350 US 421 S, LILLINGTON, NC 27546-6760
(910) 893-1210
Mailing address
2231 MARQUEE LN, FUQUAY VARINA, NC 27526-3208
(678) 826-6103
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-11587
NC
Other
Enumeration date
01/16/2021
Last updated
12/24/2024
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