Provider First Line Business Practice Location Address:
1686 SAM POTTS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALLSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28442-9458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-640-1456
Provider Business Practice Location Address Fax Number:
910-640-1423
Provider Enumeration Date:
10/16/2008