Provider First Line Business Practice Location Address:
609 E 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TABOR CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28463-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-653-2863
Provider Business Practice Location Address Fax Number:
910-377-3373
Provider Enumeration Date:
05/10/2006