Graduated: 2002
NPI: 1851470215
Practice Locations (4)
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
LIFESOURCE OF NORTH CAROLINA
939 SPRINGDALE DR
CLINTON, SC 293257266
9107429243
LIFESOURCE PRIME INC
939 SPRINGDALE DR
CLINTON, SC 293257266
9107429243
Source: CMS National Downloadable File, September 2026.