Provider First Line Business Practice Location Address:
JOHNSON HALL BUILDING
Provider Second Line Business Practice Location Address:
X3973 URBAN FREEDOM PASS
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-908-5330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2009