Provider First Line Business Practice Location Address:
1301 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-486-8080
Provider Business Practice Location Address Fax Number:
910-486-8090
Provider Enumeration Date:
07/28/2005