Organization
THE INSTITUTE OF LIFESTYLE AND WEIGHT MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EZRA BROOKS WILKINS M.D. (PRESIDENT AND CEO)
(919) 791-1112
Entity
Organization
Contact information
Practice address
3100 DURALEIGH RD, SUITE 200, RALEIGH, NC 27612-8106
(919) 791-1112
Mailing address
3100 DURALEIGH RD, SUITE 200, RALEIGH, NC 27612-8106
(919) 791-1112
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
00987496
NC
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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