Provider First Line Business Practice Location Address:
1147 NC HIGHWAY 561 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AULANDER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27805-9208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-513-8002
Provider Business Practice Location Address Fax Number:
252-332-6028
Provider Enumeration Date:
08/15/2025