Provider First Line Business Practice Location Address:
404 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:
28466-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-3380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007