Provider First Line Business Practice Location Address:
212 DUPLIN STR
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:
28349-0485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-1666
Provider Business Practice Location Address Fax Number:
910-296-1108
Provider Enumeration Date:
01/23/2008