Provider First Line Business Practice Location Address:
1320 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-485-8955
Provider Business Practice Location Address Fax Number:
910-485-8958
Provider Enumeration Date:
06/01/2005