Provider First Line Business Practice Location Address:
212 DUPLIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-6024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0787
Provider Business Practice Location Address Fax Number:
910-296-0879
Provider Enumeration Date:
06/30/2005