Provider First Line Business Practice Location Address:
144 LIBERTY SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANASVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-275-0060
Provider Business Practice Location Address Fax Number:
910-275-0162
Provider Enumeration Date:
09/11/2014