Provider First Line Business Practice Location Address:
1436 BLAND SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRELLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28444-7609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-532-4805
Provider Business Practice Location Address Fax Number:
910-532-2766
Provider Enumeration Date:
03/31/2011