Provider First Line Business Practice Location Address:
500 S FAYETTEVILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEMBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28385-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-525-4628
Provider Business Practice Location Address Fax Number:
910-525-6585
Provider Enumeration Date:
03/08/2007