Provider First Line Business Practice Location Address:
112 WEST COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEMBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-525-4490
Provider Business Practice Location Address Fax Number:
910-525-3346
Provider Enumeration Date:
01/05/2007