Organization
HER SECRET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RYEAN LEE (OWNER)
(704) 617-5073
Entity
Organization
Contact information
Practice address
14111 LAKE CROSSING DR, CHARLOTTE, NC 28278-7661
(704) 617-5073
Mailing address
14111 LAKE CROSSING DR, CHARLOTTE, NC 28278-7661
(704) 617-5073
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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