Provider First Line Business Practice Location Address:
9928 N. W.R. LATHAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-272-3051
Provider Business Practice Location Address Fax Number:
910-738-3764
Provider Enumeration Date:
01/31/2008