Provider First Line Business Practice Location Address:
116 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-2937
Provider Business Practice Location Address Fax Number:
910-285-8550
Provider Enumeration Date:
12/17/2009