Provider First Line Business Practice Location Address:
17230 US HIGHWAY 17 N
Provider Second Line Business Practice Location Address:
STE 222
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28443-7465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-270-2223
Provider Business Practice Location Address Fax Number:
910-270-2237
Provider Enumeration Date:
11/30/2006