Provider First Line Business Practice Location Address:
401 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-963-9066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005