Provider First Line Business Practice Location Address:
229 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28377-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-843-9991
Provider Business Practice Location Address Fax Number:
910-843-9995
Provider Enumeration Date:
06/22/2006