Provider First Line Business Practice Location Address:
257 HOSPITAL DR
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
BOLLIVIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28422-8665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-662-9500
Provider Business Practice Location Address Fax Number:
910-662-9501
Provider Enumeration Date:
07/11/2005