Provider First Line Business Practice Location Address:
600 AMITY PARK RD
Provider Second Line Business Practice Location Address:
DENTAL-AVERY MITCHELL CORRECTIONAL INSTITUTION
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-765-0229
Provider Business Practice Location Address Fax Number:
828-766-7015
Provider Enumeration Date:
03/27/2007