Provider First Line Business Practice Location Address:
271 LESLIE CAMPBELL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUIES CREEK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-893-4162
Provider Business Practice Location Address Fax Number:
910-897-8932
Provider Enumeration Date:
11/17/2010