Provider First Line Business Practice Location Address:
276 NC HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE LURE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-625-0748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007