Provider First Line Business Practice Location Address:
OLD GEORGETOWN CENTRE HWY 179
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
CALABASH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-512-0524
Provider Business Practice Location Address Fax Number:
910-575-0131
Provider Enumeration Date:
11/09/2006