Individual
MARY M BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
4300 FAYETTEVILLE RD, LUMBERTON, NC 28358-2677
(910) 671-5830
Mailing address
300 W 27TH ST, ATTN: WILLIAM J GUTEKUNST, LUMBERTON, NC 28358-3075
(910) 671-5000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L000588
NC
Other
Enumeration date
07/15/2005
Last updated
07/08/2007
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