Provider First Line Business Practice Location Address:
584 HOSPITAL DR NE UNIT E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLIVIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28422-0020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-662-9500
Provider Business Practice Location Address Fax Number:
910-662-9501
Provider Enumeration Date:
06/27/2007