Provider First Line Business Practice Location Address:
4601 US HIGHWAY 220 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27358-9207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-1324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2016