Provider First Line Business Practice Location Address:
2500 NC 742 S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-8325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-804-4665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2009