Provider First Line Business Practice Location Address:
612-10 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-2250
Provider Business Practice Location Address Fax Number:
910-642-0109
Provider Enumeration Date:
09/14/2006