Provider First Line Business Practice Location Address:
CLARK HEALTH CENTER 5-4257 BASTOGNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-9379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007