Provider First Line Business Practice Location Address:
101 S WEBB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27576-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-351-0084
Provider Business Practice Location Address Fax Number:
919-351-0103
Provider Enumeration Date:
12/04/2006