Provider First Line Business Practice Location Address:
16526 NC HIGHWAY 87 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAR HEEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28392-8608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-872-5720
Provider Business Practice Location Address Fax Number:
910-872-3711
Provider Enumeration Date:
02/19/2008