Provider First Line Business Practice Location Address:
104 N SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT GILEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-439-4398
Provider Business Practice Location Address Fax Number:
910-439-5540
Provider Enumeration Date:
10/30/2006