Provider First Line Business Practice Location Address:
204 UNION CHAPEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-9744
Provider Business Practice Location Address Fax Number:
910-521-1310
Provider Enumeration Date:
08/26/2006