Provider First Line Business Practice Location Address:
5642 NC HWY 41 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLACE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-285-6114
Provider Business Practice Location Address Fax Number:
910-552-2078
Provider Enumeration Date:
09/20/2006