Provider First Line Business Practice Location Address:
107 W WADE STREET
Provider Second Line Business Practice Location Address:
SUITE 107-H
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-367-6797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2009