Provider First Line Business Practice Location Address:
1100 S CLINTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
DUNN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-892-0027
Provider Business Practice Location Address Fax Number:
910-892-0029
Provider Enumeration Date:
08/03/2006