Organization
LBS4LBS ATHLETIC CENTER, CDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALTON M ROGERS (OWNER)
(252) 375-7763
Entity
Organization
Contact information
Practice address
143 EMILY DR # 4, WINTERVILLE, NC 28590-8448
(252) 375-7763
(252) 294-1137
Mailing address
143 EMILY DR # 4, WINTERVILLE, NC 28590-8448
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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