Provider First Line Business Practice Location Address:
113 NE 39TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK ISLAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28465-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
242-341-2014
Provider Business Practice Location Address Fax Number:
910-278-7721
Provider Enumeration Date:
02/04/2008