Organization
GSB ENTERPRISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM GRAHAM HAIR LOSS SPECIALIST (OWNER/OPERATOR)
(919) 940-1785
Entity
Organization
Contact information
Practice address
733 W JOHNSON ST, RALEIGH, NC 27603-1259
(919) 940-1785
Mailing address
2033 SHINGLEBACK DR, WAKE FOREST, NC 27587-6554
(919) 940-1785
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
6570
NC
Other
Enumeration date
02/25/2018
Last updated
02/25/2018
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