Provider First Line Business Practice Location Address:
225 W PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-986-0935
Provider Business Practice Location Address Fax Number:
910-986-0935
Provider Enumeration Date:
11/11/2005