Provider First Line Business Practice Location Address:
496 BALSAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-766-9977
Provider Business Practice Location Address Fax Number:
828-766-7454
Provider Enumeration Date:
12/19/2006