Provider First Line Business Practice Location Address:
109 N JK POWELL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-640-2823
Provider Business Practice Location Address Fax Number:
910-640-3327
Provider Enumeration Date:
11/01/2006