Provider First Line Business Practice Location Address:
274 SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLERBE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-652-6261
Provider Business Practice Location Address Fax Number:
910-652-2469
Provider Enumeration Date:
06/11/2006