Provider First Line Business Practice Location Address:
1119 N. US HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKINGHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-997-4464
Provider Business Practice Location Address Fax Number:
910-997-4484
Provider Enumeration Date:
07/27/2005