Provider First Line Business Practice Location Address:
14065 NC HIGHWAY 42 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27542-8231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-549-3115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2026