Provider First Line Business Practice Location Address:
218B S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TABOR CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28463-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-653-6169
Provider Business Practice Location Address Fax Number:
910-653-6078
Provider Enumeration Date:
08/22/2006