Provider First Line Business Practice Location Address:
5615 S NC 41 HWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-6216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-5050
Provider Business Practice Location Address Fax Number:
910-285-2968
Provider Enumeration Date:
05/04/2006