Provider First Line Business Practice Location Address:
509 WEST THIRD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-522-0001
Provider Business Practice Location Address Fax Number:
910-521-3411
Provider Enumeration Date:
12/28/2007