Provider First Line Business Practice Location Address:
14508 JAMES B WHITE HWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TABOR CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28463-8358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-653-7000
Provider Business Practice Location Address Fax Number:
910-653-7004
Provider Enumeration Date:
06/01/2005