Provider First Line Business Practice Location Address:
2137 SPRING BRANCH RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAR HEEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-862-2696
Provider Business Practice Location Address Fax Number:
910-862-2696
Provider Enumeration Date:
09/27/2007