Individual
MINI HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
509 W GANNON AVE, ZEBULON, NC 27597-2509
(919) 269-9621
Mailing address
509 W GANNON AVE, ZEBULON, NC 27597-2509
(919) 269-9621
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
905
NC
Other
Enumeration date
06/06/2008
Last updated
06/06/2008
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