Provider First Line Business Practice Location Address:
209 E WADE ST
Provider Second Line Business Practice Location Address:
SUITE 107 - C
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-238-0338
Provider Business Practice Location Address Fax Number:
704-238-0689
Provider Enumeration Date:
01/10/2008