Graduated: 1998
NPI: 1578564803
Practice Locations (3)
LEGACY HEALTHCARE SERVICES INC
2701 PICKETT RD
DURHAM, NC 277055688
9194199600
LIFESOURCE OF NORTH CAROLINA
3205 RANDALL PKWY, SUITE 105
WILMINGTON, NC 284032565
9107429243
LIFESOURCE PRIME INC
3205 RANDALL PKWY, SUITE 105
WILMINGTON, NC 284032565
9107429243
Source: CMS National Downloadable File, September 2026.