Provider First Line Business Practice Location Address:
90 MEDICAL CENTER DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPPLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28461-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-269-2420
Provider Business Practice Location Address Fax Number:
910-269-2410
Provider Enumeration Date:
02/17/2006