Provider First Line Business Practice Location Address:
2150 HIGHWAY #56 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREEDMOOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-257-5522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007