Provider First Line Business Practice Location Address:
135 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28377-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-843-9524
Provider Business Practice Location Address Fax Number:
910-843-9310
Provider Enumeration Date:
08/04/2006