Provider First Line Business Practice Location Address:
210 LIMESTONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-9031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-275-0058
Provider Business Practice Location Address Fax Number:
910-275-0093
Provider Enumeration Date:
11/04/2009