Provider First Line Business Practice Location Address:
302 LIMESTONE RD.
Provider Second Line Business Practice Location Address:
HWY 50
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0310
Provider Business Practice Location Address Fax Number:
910-525-4963
Provider Enumeration Date:
11/06/2006