Provider First Line Business Practice Location Address:
115 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-5216
Provider Business Practice Location Address Fax Number:
910-259-4063
Provider Enumeration Date:
04/30/2009