Provider First Line Business Practice Location Address:
4851 HWY 421 S.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUIES CREEK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-893-5727
Provider Business Practice Location Address Fax Number:
910-893-6404
Provider Enumeration Date:
04/26/2007