Provider First Line Business Practice Location Address:
239 W PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-215-7155
Provider Business Practice Location Address Fax Number:
910-944-5901
Provider Enumeration Date:
06/14/2007