Provider First Line Business Practice Location Address:
13775 NC HIGHWAY 50
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
SURF CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28445-6967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-329-0011
Provider Business Practice Location Address Fax Number:
910-329-0089
Provider Enumeration Date:
12/27/2006