Provider First Line Business Practice Location Address:
143 MAIN STREET
Provider Second Line Business Practice Location Address:
CAMPBELL UNIVERSITY, TAYLOR HALL, B-20
Provider Business Practice Location Address City Name:
BUIES CREEK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-988-5877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2006