Organization
ILLUMINATED DIRECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN DALANDISH LACEWELL (OWNER)
(919) 452-7931
Entity
Organization
Contact information
Practice address
800 N MANGUM ST STE 104, DURHAM, NC 27701-2260
(919) 450-6446
(888) 227-5443
Mailing address
2628 CAMELLIA DR, APT C, DURHAM, NC 27705-2054
(919) 452-7931
(888) 227-5443
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
05/06/2014
Last updated
05/06/2014
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