Provider First Line Business Practice Location Address:
221 CENTER ST
Provider Second Line Business Practice Location Address:
221 CENTER ST
Provider Business Practice Location Address City Name:
STAR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27356-0602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-428-4675
Provider Business Practice Location Address Fax Number:
910-428-1518
Provider Enumeration Date:
03/27/2007