Provider First Line Business Practice Location Address:
195 W ILLINOIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-692-2444
Provider Business Practice Location Address Fax Number:
910-692-3651
Provider Enumeration Date:
11/30/2006