Provider First Line Business Practice Location Address:
114 NE RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-4187
Provider Business Practice Location Address Fax Number:
910-285-7824
Provider Enumeration Date:
10/12/2006