Provider First Line Business Practice Location Address:
1489 HWY 701 S.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-862-4136
Provider Business Practice Location Address Fax Number:
910-862-4277
Provider Enumeration Date:
10/26/2006