Provider First Line Business Practice Location Address:
1015 NC HIGHWAY 150 W
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUMMERFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27358-9197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-447-7550
Provider Business Practice Location Address Fax Number:
336-447-7551
Provider Enumeration Date:
06/14/2007