Provider First Line Business Practice Location Address:
2160 MIDLAND RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-295-3220
Provider Business Practice Location Address Fax Number:
910-295-0507
Provider Enumeration Date:
05/13/2006