Provider First Line Business Practice Location Address:
5650 S NC 41 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28466-6094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-6424
Provider Business Practice Location Address Fax Number:
910-285-6928
Provider Enumeration Date:
09/25/2007