Provider First Line Business Practice Location Address:
13A BIRMINGHAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WRIGHTSVILLE BEACH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28480-2845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-598-2200
Provider Business Practice Location Address Fax Number:
910-406-5686
Provider Enumeration Date:
10/31/2006