Provider First Line Business Practice Location Address:
134 LIBERTY SQUARE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0500
Provider Business Practice Location Address Fax Number:
910-296-0515
Provider Enumeration Date:
08/08/2011