Provider First Line Business Practice Location Address:
302 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUCAMA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-239-0140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2013