Provider First Line Business Practice Location Address:
117 BEASLEY ST, 2ND FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-9822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2007